AB0280 SERIOUS INFECTIONS-RELATED HOSPITALIZATION IN RHEUMATOID ARTHRITIS. OBSERVATIONAL STUDY OF 392 PATIENTS FROM A SINGLE UNIVERSITY CENTER
Authors: L. C. Domínguez-Casas, P. Rodriguez Cundin, T. Dierssen-Sotos, N. Vegas-Revenga, A. Corrales, M. A. González-Gay, R. Blanco
Journal: Annals of the Rheumatic Diseases (2022)

Background Patients with Rheumatoid Arthritis (RA) have an increased risk of infections. This may belinked to disease-related, the immunosuppressive therapy and the co-morbidities. Objectives in an unselected group of RA patients, our aim was to assess the a )incidence b )features of disease and c )predictive factors of serious infections-related hospitalization. Methods Observational study of all patients diagnosed with RA that were included in the vaccination program of our university hospital between October2011 and October 2016.The minimum follow-up was of 12 months; therefore, it was made until December 2020. Patients with serious infections-related hospitalization were a ) compared with those not requiring hospital admission and, b )identified predictive factors (multivariate analysis adjusted by age and sex). Vaccination program in our hospital includes vaccination for Influenza, Streptococcus pneumoniae and Haemophilus influenzae. Information on patients, infections and hospitalizations was retrieved from the hospital and general physician records. Results We studied 392RApatients (309women/83men); mean age 63.1±13.7 years. After a mean follow-up of 71.8±20.6 months, in 88 of 392patients (22.4%) (60 women) 187serious infections-related hospitalizations were required. The median [IQR] number of hospitalizations were 1.5 [1-2]. The main serious infections were respiratory (44 patients; 78 hospitalizations), urinary (33 patients; 48 hospitalization), cutaneous (19 patients; 28 hospitalizations), abdominal (17 patients, 20 hospitalizations), septic arthritis (7 patients; 8 hospitalizations), maxillofacial(2 patients, 2 hospitalizations), bacterial endocarditis (2 patients, 2 hospitalizations) and genital (1 patient, 1 hospitalization). Patients with serious infections-related hospitalization were older, with a longer RA, with more co-morbidities (hypertension, hypercholesterolemia diabetes mellitus, and Interstitial lung disease) and with more conventional and biological DMARDS (Table 1). Table 1. Comparative study of different groups Patientswithserious infections-related hospitalization N=88 Patients without serious infections-related hospitalization N=304 p Demographic features and comorbidities Age (years),mean±SD 69.7±11.2 59.2±12.6 0.005 Women, n (%) 60 (68.2) 249 (81.9) 0.33 Active smokers, n (%) 41 (46.6) 114 (7.5) 0.32 Hypertension, n (%) 56 (63.6) 109 (35.8) 0.004 Hypercholesterolemia, n(%) 47 (53.4) 101 (33.2) 0.02 Diebetes Mellitus, n(%) 25 (28.4) 30 (9.9) 0.0002 RA features Duration of RA (months) mean±SD 165.8±130.1 128.6±102.6 0.005 Positive RF, n (%) 52(59.1) 171(56.2) 0.80 Positive ACPA, n (%) 48 (54.5) 158 (52.6) 0.81 Erosive disease, n (%) 32 (36.4) 113 (51.9) 0.89 Associated Sjögren Syndrome, n (%) 4 (4.5) 16 (5.3) 0.79 Interstitial lung disease n (%) 11 (12.5) 9 (2.9) 0.0008 Subcutaneousnodules n (%) 6 (6.8) 16 (5.3) 0.57 Prednisone (or equivalent) dose mg/day, mean±SD 5.3±4.5 3.3±3.8 0.001 Number of convencional DMARDs, mean±SD 1.9±1.4 1.5±1.3 0.05 Number of biologic DMARDs, mean±SD 0.1±0.2 0.1±0.4 0.03 Number of JAK inhibitors, mean±SD 69.7±11.2 59.2±12.6 0.1 The predictive factors for hospitalization were hypertension and Diabetes Mellitus, RA related interstitial lung disease and treatment with biologic DMARDs. (Figure 1) Figure 1. Predictive factors for serious infections-related hospitalization Conclusion Despite to be included in a vaccination program up to 22% of patients required hospitalization due to serious infection. The main predictive factors were co-morbidities, interstitial lung disease and treatment with biologic DMARDs. Serious infections in RA remain to be an unmet need. Disclosure of Interests None declared